Association and Prognostic Implication of C-Reactive Protein with Risk of 1-Year Death or Disabling Stroke After Transcatheter Aortic Valve Replacement

Background: Recent data suggest that serum biomarkers may predict worse outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). We examined the association and predictive value of preprocedural levels of C-reactive protein (CRP) with clinical outcomes after TAVR. Methods: We evaluated 243 patients who had undergone successful TAVR and had a valid measurement of baseline CRP level between March 2010 and February 2017. The primary endpoint was the composite of death from any cause or disabling stroke at 12 months. Results: During follow-up (median, 13.7 months), primary outcome events occurred in 18 patients (8.2%), including 14 deaths (6.7%) and 5 disabling strokes (2.1%). Patients with high serum levels of CRP (≥3.0 mg/L) had a significantly higher 1-year rate of death or disabling stroke compared to those with normal CRP levels (16.7% vs. 5.5%, P = 0.009). In the multivariate Cox-proportional hazard model, an elevated level of CRP was identified as an independent predictor of 1-year death or disabling stroke (hazard ratio, 2.84; 95% confidence interval, 1.10–7.34; P = 0.03). After the addition of information about CRP concentration to the Society of Thoracic Surgeons (STS) score model, the C-index for the prediction of death or disabling stroke substantially increased from 0.655 to 0.710, and a continuous net reclassification improvement of 0.529 (0.054–1.004) was noted. And there was no significant relationship between the primary outcome and other biomarkers, included B-type natriuretic peptide (BNP) and troponin I, in our study. Conclusions: In patients undergoing TAVR, elevated CRP levels were significantly associated with an increased risk of death or disabling stroke and also augmented event prediction, suggesting that CRP could be used as biomarker into a risk prediction model for TAVR.研究背景：近期研究数据表明，血清生物标志物可预测经导管主动脉瓣置换术（transcatheter aortic valve replacement, TAVR）患者的不良临床预后。本研究旨在探讨术前C反应蛋白（C-reactive protein, CRP）水平与TAVR术后临床结局的关联及其预测价值。方法：本研究纳入2010年3月至2017年2月期间接受成功TAVR且具备基线CRP水平有效检测数据的243例患者。主要终点为术后12个月全因死亡或致残性脑卒中的复合终点事件。结果：随访期间（中位随访时长13.7个月），共计18例患者（8.2%）发生主要终点事件，其中14例死于任何原因（6.7%）、5例出现致残性脑卒中（2.1%）。血清CRP水平升高（≥3.0 mg/L）的患者，其1年全因死亡或致残性脑卒中发生率显著高于CRP水平正常者（16.7% vs. 5.5%，P=0.009）。多因素Cox比例风险回归模型分析显示，CRP水平升高是1年全因死亡或致残性脑卒中的独立预测因素（风险比：2.84；95%置信区间：1.10~7.34；P=0.03）。将CRP浓度信息纳入胸外科医师学会（Society of Thoracic Surgeons, STS）评分模型后，预测全因死亡或致残性脑卒中的C统计量从0.655显著提升至0.710，且连续净重新分类指数为0.529（95%置信区间：0.054~1.004）。本研究中，主要终点与其他生物标志物（包括B型钠尿肽（B-type natriuretic peptide, BNP）和肌钙蛋白I）无显著相关性。结论：在接受TAVR的患者中，CRP水平升高与全因死亡或致残性脑卒中风险升高显著相关，且可增强事件预测效能，提示CRP可作为TAVR风险预测模型中的实用生物标志物。